We are currently conducting an RCT of an acute physician on duty in the ED
seeing all medical patients referred for admission. The main outcome is mean
number of medical admissions perday. We hope it will provide some insight
into the 'value' of acute physicians who have more medical experience than
most ED SHO's in redirecting patients to more appropriate care than an acute
bed. There have been no other studies which have explored the role of the
acute physician in this way. There has been work on admission avoidance
schemes for specific conditions such as Chest pain, DVT, PE (and hopefully
soon to be published our own work on SAH rule-out). This work has invovled
the use of protocols to risk stratify patients and investigate them
accordingly - which may not be what you want. I think you will struggle to
find refs unless you cast your net wider to look at admission avoidance in
general in which case you should find some papers as outlined above (try
Steve Goodacre or K Richell-Herren's work on chest pain). There have been a
number of papers which have also looked at alternatives to acute care (such
as hospital-at home for patients with exacerbations of COPD etc) which may
be useful to illustrate your point. If you really cannot find these through
medline, then email me offline and I will help!
Sue Mason
Senior Clinical Lecturer in Emergency Medicine
Sheffield
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----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, March 08, 2002 9:40 AM
Subject: bed pressures and admission avoidance
> Dear all,
> I'm trying to dig out articles on admission avoidance - with regard to the
benefit or otherwise of "acute physicians" seeing medical patients in the
ED/rapid access clinics etc.
> There was the Hardy et al paper in EMJ last year, but that was more about
rehab/COTE.
> Ideally I'm trying to find evidence on senior (general) physicians seeing
acute medical patients in the ED, for rapid assessment and initiation of
treatment with early (next day?) follow up. Eg, ?PE, ?ACS, ?Headache, ?TIA,
CQC, first fits - the sort of presentations that the on call medical juniors
usually admit for later investigation/obs.
> Using OVID Medline hasn't been helpful so far. Any one on the list know of
any good papers?
> Thanks,
> Giles Cattermole
> SpR EM, Cardiff
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